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7 <br /> APPLICATION FOR WELUPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> 17 y Srrh wn�J K'B Ftl ORBLE PERM EXPIRES I YEAR FROM DATE ISSUED <br /> Memphis In TFpRnul j <br /> APPLICATION IS HERE BY MADE TO THE SAN JOAOUM COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR IN6fAM THE WUPR DESCRIIED.THIS APPLICATION f8 MADE IN COMR)IwCE WITII SAN <br /> JOAOMN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1113.3 AND THE BfANOAADS OF IAN JOAOUJN`C(t�I MTV iVBUC HEALTH SERVICES,ENVIRONMENTAL HEALTH OMSgN, <br /> Joe ADDIEBSJOR APN, B E THA N Y R D. '/u M I. E. O F B Y R 0 N cfTY jj y y TRACY PARCEL,IZVAPHP <br /> oWNESBIYAME _EVERETT RANKIPJS ADDRESS 16850 TRACY BLVD. TRACY PHONE, 836-1638 <br /> CONTRACTOR HENNI14GS 5R05. DRILLING CO. INC. AODE@@ 3525 PELANDALE MOD uc, 290813 PNDNE, 545-1185 ` <br /> SUB CPNfRACTOR ADD/EBB UC/ PHONE, V <br /> ffiE OP WELLNUMP. IU NEW WELL ❑REPLACEMENT WELL ❑MONITORNO WELL, ❑OTHER <br /> ❑INSfALLATION ❑WELL 11MEM REPAIR ❑eRgeRCORNECT REPAIR ❑VAPOR EXTRACTION WELL, J <br /> ❑Nw.L7 R.E.1• N.P. DEPTH PUMP BET FT. FIRST WATER LEVEL O <br /> fTYPE Of PUMP) �-R [\l <br /> Elow-vF-@ERVNCE WELL LJ GEOPHYSICAL WELL, ❑ fIOR somNO <br /> ❑DESTRUCT bPC n <br /> INT Om USE TIM OF WILL CONSTRUCTION 5MIFIGARONS Ate' <br /> ❑WMMWAL ❑OPEN BOTTOM DIA.OF WELL EXCAVATION 1211 <br /> CIA.OF CONDUCTOR CASINO �p <br /> nOOMESRN <br /> fICAPVATE nORAVEL PACKMZE TYPE OF CASOJSTEEL�PM PVC OfA,OF WELL CASINO L II D ' <br /> ❑PHBUCMUNICfPAL ❑bFIVFN DEPTH OF OROUT SEAL 1 0 0 1 SPECIFICATION BENTONITE A _ <br /> CI BTRIGATIONfAO ❑OTHER OROUT SEAL INSTALLFC BY H E N N I N GS OAOUT BRAND NAME v, E� <br /> ❑MOMONNO 200 L OROVT SEAL PUMPEO•.KI V- ❑N. CDIaCIETE PEDESTAL BY OmLLER:❑Ys. �3 Ns s <br /> APPROX.DP?H LOCKING CHESTER SOXMIOVE PIPE ,S <br /> PROPOSID CORRETTUCTIONA)MLSM METNOD: MUD ROTARY X X AIR ROTARY AUGER CABLE OTHER <br /> �y <br /> I HERESY CERTIFY THAT I HAVE PREPARED TRII APPLICATION AND THAT THE WORK WILL BE DONE N ACCORDANCE WITH SAN JOAQUN COUNTY OIOINAMCFS,STATE LAW@.AND RULES AND f ,n <br /> REGULATIONS OF THE RAN JOAOVN COUNTY.NOME OWNER OR LICENSED AOENT'I SIGNATURE CERTIFIES THE FOUOWNOT'1 CERTIFY THAT N THE PH►ORMIANCE OFTIE WORK FOR WHICH V <br /> TM@ PERMIT M 1@SUED,I SHALL NOT EMPLOY PFRSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF C"01419IA.-CONTRACTOR•@ HIRING OR SUllII <br /> CONTRACTINO GRATURE CERTIFIES- <br /> THE FOLLOWSO: '1 CEITVFY THAT N T/E PERFORMANCE OF THE WORK FOR WIMH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERBONS SUBJECT TO WOOMMAR'S COMPp1IATIVN LAWS OF <br /> CALLFOIMA-' THIN APPLICANT MUST CALL 74 HOURS IN ADVANCI EOR ALL MQURW INSKCl" T 111 4@@•• ",COMP l DINMMLO AT LOWER IA PROVIDE . <br /> @I..dx_ on.Y.sn-8� ti�nooy .c• June 9, 1998 <br /> ROT RAR ID—R.@.Y.1 <br /> 1. NAMES Of STREET@ OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION Of HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2.OUTLINE OP THE PROPERTY,ONSIO V WENIONS AND NORTH DIRECTION, EXPANSION OF IEWA(E DT@POBAL SYSTEM@. <br /> ]-DIMENSIONED OUTLINER AND LOCATION OF ALL VaSTSIO AND PROPOSED S.LOCATION OF MILLI W rrHlN RAMS OF ONE HUNDRED FIFTY FT, <br /> BT IUCTUPEI.INCLUDM COVERED AREAS SUCH AB PATIOS,DRIVEWAYS,AND WALL@. ON THE PROPERTY OR ANdaSRNQ PROPERTY. <br /> K h <br /> 3 <br /> Ia <br /> J � <br /> _ I %Tj <br /> En <br /> ty <br /> l PAYMENT <br /> REGE!VEr <br /> JUN: 1 1998 <br /> 71 <br /> .� ,. :. .. ..SAKJOAUUIN CUUNT.f . <br /> PUBUC HEALTH SERVII-C <br /> .I ENVIRONMENTAL <br /> DEPARTMENT DSI ONLY <br /> Apps—k-A.-pl.r BY On. O Mw <br /> O..uI Irnp.atin.01 -Z ,-,Q-B P—P InE Eta BY DR. <br /> b.w.wNon bgp..11.n <br /> cemm.r.r.r 10 <br /> ACCOUNRNO OILY; AID@ FAC! <br /> PE CODES FEE INFO AMOUNT FIEWIT11J RE )CASH RECEIVED BY DATE R9IMITISFRSRCE REOUEST NIXN@q INVOICE <br /> Q <br />